Sleep apnea causes repeated breathing interruptions during sleep. Stimulating the hypoglossal nerve in the tongue using an implanted pacemaker-like system can improve a patient’s breathing and sleep.
Sleep apnea is a common condition where a person stops breathing repeatedly during sleep. It can occur due to obstruction of the upper airways, improper brain signaling, or both. An episode of sleep apnea may last for
Obstructive sleep apnea can
Hypoglossal nerve stimulation implantation surgery
This article outlines how a sleep apnea implant works and the possible risks. It also provides information on the cost, procedure, and alternative treatments.
The implant is an artificial device that surgeons insert into a person’s body to improve breathing. It is also called an upper airway stimulation device or hypoglossal nerve stimulator.
Presently, the Inspire upper airway stimulation system is the only
An otolaryngologist or ear, nose, and throat specialist can perform implant surgery. They will implant the pacemaker-like device in the upper right chest beneath the skin.
The sleep apnea implant detects a person’s breathing pattern and generates mild electrical impulses to open the airways. It features four main parts that include:
- Generator: The surgeon will place the generator directly beneath a person’s clavicle, which is the collar bone. It is the part of the device that creates the electrical impulse.
- Breathing sensor: The breathing sensor connects to the generator. A surgeon will implant the breathing sensor in the side of the chest near a person’s ribs.
- Stimulation electrode: The surgeon places a wire that goes from the generator to the hypoglossal nerve. The end of the wire is a stimulation electrode connected to a branch of the hypoglossal nerve of the tongue.
- Remote: The remote is an external hand-held component of the device. A person can use the remote to switch the implant on or off, control the intensity of stimulation, or pause the neurostimulation.
The breathing sensor detects breathing and sends signals to the generator when a person breathes. This, in turn, activates the generator to send alerts to the stimulation electrodes to act on the hypoglossal nerve. The hypoglossal nerve is the nerve responsible for tongue movement.
As electrical impulses stimulate the hypoglossal nerve, the tongue muscles move forward to open up the upper airways, improve airflow, and reduce sleep apnea. A person can use the remote control to regulate the device.
A doctor will advise about how to manage the device and may recommend using it alongside other treatments.
Before sleep apnea implant surgery, a surgeon
A person may be a good candidate if:
- they are over 18
- they have moderate to severe OSA
- they have a body mass index (BMI) of less than 32
- that drug-induced endoscopy shows they are good candidates
- they are unable to have their tonsils removed
- they are unable or unwilling to use a continuous positive airway pressure (CPAP) device
- other OSA treatments have failed to treat their condition
However, a person should avoid sleep apnea implants if they:
- are pregnant or plan to become pregnant
- have an unsuitable upper airway as determined by sleep endoscopy
- frequently get or need an MRI scan
- are unable to operate the remote
- have any condition that can block their upper airway
- may undergo any procedure that could affect their upper airway
- have an implanted device that can interact with the sleep apnea device
Various studies have shown that sleep apnea implants can effectively treat OSA.
A 2020 study found that hypoglossal nerve stimulation resulted in better outcomes for people with OSA, allowing them to sleep better.
In addition, a
Implant surgery is a same-day outpatient procedure, and a surgeon can perform it in a hospital or an accredited surgical facility. The procedure takes
Sleep apnea implant surgery
- The surgeon will administer a general anesthetic to prevent pain during the surgery.
- The surgery involves three small incisions. The surgeon will make the first incision in the right upper neck region around the hypoglossal nerve, below the jaw.
- The surgeon will place the stimulator cuff around the hypoglossal nerve so that the stimulation wire wraps one of its distal ends. They will sterilize the cuff with saline and test it using a generator or external nerve stimulator.
- The surgeon will make a second incision on the same side as the first but in the upper chest region to implant the pulse generator.
- They will make the third incision on the same side under the ribs, where they will implant the breathing sensor.
- The surgeon will connect the three implanted components and conduct electrical testing to ensure adequate signal and tongue contraction.
- The surgeon will close the incisions with sutures or stitches.
- The generator will not be turned on right away. Healing is allowed to occur and the settings for the generator are determined, most often during a sleep lab test.
Some potential risks and side effects of sleep apnea implant surgery include:
- swelling at incision sites
- nerve trauma or damage
- fibrosis, which is thickening or scarring of the skin
- pain, numbness, or irritation
- allergic reaction or rejection of the implanted material
- dry mouth
- tongue soreness and restricted movement
- excessive bleeding
- problems with speaking or swallowing
- undesirable changes in stimulation due to faulty connections
- short term symptoms such as headaches, coughing, choking, and changes in speech
A person should discuss with their surgeon if they have any concerns or are experiencing any discomfort after surgery. The surgeon will evaluate the person and determine the best treatment.
While sleep apnea implants are effective, some individuals may be suitable candidates for other sleep apnea treatment methods. These
- positive airway pressure therapy (PAP)
- lifestyle changes
- oral devices
- other surgical procedures
According to a
The battery of the device can last for
The American Thoracic Society (ATS) notes that the implant procedure is generally well-tolerated with minimal risks. It is normal for people to experience mild pain after implant surgery. This should resolve after taking prescribed pain medications.
The ATS say that in 1% of people, abnormal tongue movement may occur due to temporary nerve injury. This should resolve naturally within 6–8 weeks. The doctor will turn on the device at an outpatient appointment 1–2 months after surgery to allow the wound to heal correctly. The doctor or healthcare professional will guide a person in using the device.
Although it is a minimally invasive procedure, sleep apnea implant surgery is not suitable for everyone. A person will need a thorough assessment by a sleep specialist and surgeon to determine whether they are suitable for the procedure.
Sleep apnea implant surgery has a high success rate and can offer long-term benefits for selected people with moderate to severe obstructive sleep apnea.
Anyone considering sleep implant surgery should discuss with a doctor whether it is suitable for them.